MACRA: What Employers & Medical Assistants Need to Know


Elizabeth Woodcock is a nationally recognized speaker, trainer and author dedicated to improving the business of medicine. She helps physician practices achieve and sustain patient satisfaction, practice efficiency and profitability. We met with Woodcock to gather experts take on MACRA and what it means for medical practices and medical assistants.

Below, we share some of her primary insights.

What is MACRA?

MACRA is the Medicare Access to Care and CHIP Reauthorization Act. It was passed into law in April 2015. Known as the “DocFix” bill, it corrected the flaw in the payment formula for the Medicare Physician Fee Schedule. It also outlined a new reimbursement method for physicians and other professionals billing Medicare. Although the program begins in 2019, this year is the initial performance year. (Review the law here.)

Physicians and other eligible clinicians have two pathways under the program:

  1. Advanced Alternative Payment Model (APM)
    Offers an automatic five percent increase to Medicare reimbursement.

  2. Merit-Based Incentive Payment System (MIPS)
    Offers a payment adjustment, starting with an increase or decrease of four percent in 2019 (that eventually can be up to nine percent), based on performance in four categories: Quality, Cost, Advancing Care Information (the new name for “Meaningful Use”) and Improvement Activities. Eligible clinicians will receive a composite performance score based on their performance in these areas, with payment adjustments being imposed two years after their performance is scored.

    The goal of the program is to consolidate and streamline the current pay-for-performance programs that Medicare uses including: the Physician Quality Reporting System (PQRS), the EHR Incentive Program (“Meaningful Use”) and the Value-Based Payment Modifier.

What should employers know about MACRA?

Medical practices will need to comply with the requirements outlined in MACRA or be subject to declining reimbursement. Or will they?

  1. Some medical practices may not need to worry about it at all
    Newsflash: 35 percent of physicians and other eligible clinicians won’t have to worry about MACRA. Centers for Medicare and Medicaid Services (CMS) increased the exemption range to $30,000 in total allowed Medicare Part B charges per annum (or those who treat less than 100 Medicare Part B beneficiaries). Physicians and other eligible clinicians who fall in this category will simply enjoy the straight 0.5 percent increase of the Medicare Physician Fee Schedule as outlined by MACRA.“This was probably one of the biggest shocks of the recent announcements,” Woodcock says. "This is in contrast to the current state where every clinician is being judged, except those who are new to Medicare.”

  2. MACRA is the law; QPP is the program
    The term “MACRA” has been a buzzword for the last few years, but Woodcock says it’s important to note that MACRA is the name of the law – not the program. Now that the law has passed, the actual program is called the Quality Payment Program (QPP). “People are just beginning to make this shift [in terminology],” Woodcock says.

  3. Meaningful Use is now just a component of the program
    As mentioned previously, Meaningful Use is now called Advancing Care Information (ACI), and it’s only one of four components of the QPP. “For practices that have done Meaningful Use in the past, the transition will be easy, as the new requirements are a subset of the previous ones,” Woodcock says. “That said, there are a few changes in definitions which will impact how data is recorded and reported, so reviewing and understanding the new measures is vital for success.”

  4. The Quality category will be challenging
    Woodcock says the Quality category of the Merit-Based Incentive Payment System will be a challenge, as the scores are compared to measure-specific benchmarks. This is a stark contrast to the past, in which the programs simply required reporting. The QPP is moving clinicians from a reporting program to a performance program.

What does this all mean for medical assistants (MAs)?

Care teams continue to gain importance during this time of transition, with medical assistants often being in the center of it all. “Medical assistants will be more important than ever as practices strive to reach the requirements,” Woodcock says. Specifically, here are the requirements in which Woodcock believes medical assistants will play a keyrole in the following:

  1. Quality Measures
    There are 271 Quality Measures, and Woodcock says that medical assistants should play a role in almost everyone of them! For example, one quality measure is “The percentage of patients greater than 85 years of age who received a screening colonoscopy from January 1 to December 31.”

    The medical assistant can help by manually identifying the patients who qualify and/or noting the alerts as per the EHR system. If a patient has not had the colonoscopy, the MA can then alert the physician or advanced practice provider that it should be ordered.

  2. Advancing Care Information
    There are “base” requirements for ACI outlined in MACRA, and then eligible clinicians need to gain additional points. Medical assistants can help with many of the requirements, including supporting eligible clinicians in facilitating immunization registry reporting, clinical information reconciliation and the provision of patient-specific education.

  3. Improvement Activities
    There are 92 Improvement Activities (IAs) outlined in MACRA . Physicians and other eligible clinicians must choose two or four, depending on their weight. Medical assistants can playa valuable role in many, if not most, of these activities. One example is the implementation of regular care coordination training. Medical assistants cannot only participate in the training process, but MA leads and supervisors can contribute to developing the curriculum for their colleagues.

    As physicians and other eligible clinicians implement the QPP, there is a lot of work to be done.“Physicians simply cannot do it all,” Woodcock says. It will be vital that the care teams, most notably the medical assistants, step up to ensure that the practice is compliant.







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